It is possible to suppress many kinds of pain for
dying patients without morphine. For us, to get morphine is not the main
goal; however we do use a lot of tramadol and .

To control pain without morphine:

For some diseases it is necessary to consider curative therapy
even if we cannot hope for any improvement of the causal disease. It
is especially true for Cryptococcosis which
is one of the main causes of severe pain in our ward.

Never associate pharmacological agonists with antagonists.
That means, for instance, never use pentazocin (sosegon, fortal…) because we
often also have to use anti-cough drugs using agonist derivatives.

The contraindication of corticoids usually does not hold for
dying patients (see "9-Dexamethasone")
the same is true for addiction to drugs such as tramadol,
benzodiazepines, etc.

More generally, the danger of all painkillers is that they
"mask" the occurrence of new diseases, which are sometime curable
(Crypto…)

If classical drugs seem to be inactive in treating pain from
"afferent fiber lesions" try amitryptiline 25-75mg HS, but remember the side
effects (sleepy) and/or the few days needed before effect is apparent.

3- If pain still severe and tramadol seems
to be ineffective, treat as pain from "afferent fiber lesions":
amitryptiline 25-75mg HS, but remember the side
effects (sleepy) and/or the few days needed before having any effect.